title: Examination of hyperlucent foci and clinical outcomes in pediatric cardiac patients on extracorporeal membrane oxygenation.
abstract: BACKGROUND
  A number of cardiac patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) at our institution were found to have hyperlucent foci evident on echocardiography. However, the clinical significance of these findings is not known.
  
  
  METHODS
  To investigate this phenomenon further we undertook a retrospective analysis to determine the prevalence and clinical implications of hyperlucent foci in children supported with VA-ECMO.
  
  
  RESULTS
  From January 2002 to September 2009 49 subjects were supported with VA-ECMO. Of these, 12 (24%) were found to have hyperlucent foci. Foci were multifocal in six subjects (50%) and the most common location was left ventricular wall. No association was noted between primary cardiac diagnoses, or for inciting reason for placement on ECMO (extracorporeal cardiopulmonary resuscitation vs. transition from cardiopulmonary bypass to ECMO). There was no association between the presence of the foci and death in less than 14 days following decannulation from ECMO, hospital survival 42% versus 43%, P = 0.1. Among subjects who survived at least 14 days after ECMO decannulation hyperlucent foci resolved in 5 of 7.
  
  
  CONCLUSIONS
  Hyperlucent foci can be seen in children supported by VA-ECMO. They do not portend a poorer prognosis. Among hospital survivors resolution is the norm.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Sibley Heart Center at Children's Healthcare of Atlanta, Atlanta, Georgia 30322-1062, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Brothers
authors.forename: Joseph
authors.initials: J
authors.lastname: Kreeger
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*